Enhancing awareness to break the stigma among LGBTQ+ health care workers to curb monkeypox transmission: correspondence
Authors: Saravanan Sekaran, Suresh Kumar R Sekar
Journal: International Journal of Surgery (2023)

Dear Editor, In July 2022, WHO proclaimed monkeypox (MPX) an international health emergency, and at the time of writing this letter, 83 539 cases were reported in 110 countries across the globe (https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html). The population that has close contact with individuals infected with MPX is at elevated risk of contracting the infection. Health care workers are strongly linked to the assessment, management, and direct treatment of patients with MPX infection, whether suspected or proven1. Developed countries possess a well-organized health care system with appropriate training to the workers and sensitizing them about MPX. However, in developing and less developed countries, health care workers are not trained adequately and lack the confidence to curb MPX transmission. Additionally, to gain public attention through sensationalism, the media has started to define the relationship among Men having sex with men, MPX, and HIV. This has the propensity to further stigmatize MPX carriers2. Stigma causes people to hide diseases, which spreads them untraceably and worsens outbreaks. The rise in stigma in society has disturbed the health care sector, especially health care workers. Health care professionals, particularly those belonging to the lesbian, gay, bisexual, transgender, intersex, queer/questioning(LGBTQ)+ community, who are exposed to the MPX can conceal their disease status due to the stigma in the early phases of the disease3. Another stigma is the fake narrative that MPX is a 'gay disease'. Employers in the workplace would assume that individuals who disclose they are infected with MPX are LGBTQ+ or vice versa. This provides a risk of transmitting the infection inside the hospital settings. Apart from this, in countries like India, primary health care workers are regarded as the foundation of the health care system, and they are essential for delivering health care needs to rural areas. The societal stigma and improper training will further weaken the health care system recovering from the coronavirus disease 2019 pandemic and may pose the risk of MPX transmission at a faster rate in rural areas. Hence, a vast lacuna is generated in how to fight the stigma that is linked with MPX among health care workers. We propose the following strategies that would assist the existing guidelines and recommendations framed by government and health care bodies to combat MPX transmission: Conducting one day workshop/awareness programs in hospitals and primary health care centers to sensitize health care workers and general public on MPX (strong emphasis on symptoms and transmission). Placing wall posters, pamphlets and displaying advertisements both in TV and radio emphasizing that MPX could affect anyone irrespective of gender, sex, age or sexual orientation and not only LGBTQ+. This could partially stop the circulation of fake narratives. Framing strict rules to refrain media sources from using emotionally charged language, incorrect contents, fake news, and sensational headlines pointing LGBTQ community to attain social media traffic. The gay and bisexual communities, as well as the LGBTQ+ community in general, should not be held responsible for the spread of the disease because this would further stigmatize them. In order to communicate with them, a comprehensive strategy should be combined with the use of specific channels, such as websites, dating apps, and media programmes. Overall, effective communication about MPX is crucial in combating the disease and avoiding fear and stigma. The use of polite language with patients, fostering the distribution of reliable scientific knowledge, and giving accurate and timely information on MPX symptoms and preventative techniques are crucial. This will create an environment where the disease and its effects may be discussed freely and honestly to effectively curb the outbreak. Ethical approval Not applicable. Sources of funding NIL. Author contribution Dr R.S.K., Dr S.S. performed literature search and drafted the letter. Conflicts of interest disclosure The authors declare that they have no known competing financial interests. Research registration unique identifying number (UIN) Name of the registry: not applicable. Unique identifying number or registration ID: not applicable. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor The submission is a correspondence. No new study was performed. All authors accept full responsibility for the submitted letter. Data statement The correspondence is based exclusively on resources that are publicly available on the internet and duly cited in the 'References' section. No primary data was generated and reported in this manuscript. Therefore, data has not become available to any academic repository.